A case of severe rhabdomyolysis associated with secondary adrenal insufficiency and autoimmune hepatitis

Abstract

Rhabdomyolysis is a serious and life-threatening condition which has many established causes including endocrine disturbances. Of those, thyroid, adrenal and pituitary deficiencies are the most commonly seen. Most cases of rhabdomyolysis with adrenal insufficiency that have been reported have been primary. Here, we report an encounter with a patient who presented with her second case of severe rhabdomyolysis in the setting of secondary adrenal insufficiency. The cause for corticotropic suppression was most likely autoimmune hypophysitis given the presence of other autoimmune comorbidities including a new diagnosis of autoimmune hepatitis. In addition to her case, we present a brief review of the literature pertaining to cases of rhabdomyolysis attributed to adrenal insufficiency.

Anterior hypopituitarism due to primary empty sella syndrome in a critically unwell patient

“…Empty sella syndrome often goes undiagnosed and many patients are asymptomatic,4 5 our patient was undiagnosed and experienced no symptoms until his admission, this presentation is very rare and left untreated could have been fatal.…”

“…Rare presentations such as acute psychosis or rhabdomyolysis have also been documented in literature. This has been observed in the presence or absence of hyponatraemiam, a potential mechanism is cortisol deficiency leading to muscle breakdown by impaired glycogenolysis or mitochondrial oxidative metabolism with hypotensive shock which can also result in muscle ischaemia 5…”

A suspected case of hyponatraemia induced rhabdomyolysis: a case report

“…Hyponatraemia-induced rhabdomyolysis is reported in the literature, although limited to small case series and case reports [ 1 – 8 ]. It is predominantly seen in the psychiatric population, specifically patients with chronic schizophrenia and psychogenic polydipsia [ 1 – 5 ], although cases are also reported in association with adrenal insufficiency [ 6 , 7 ] and a further case is described in a patient who compulsively drank excess water to treat a ureteric calculus [ 8 ]. This report describes a case whereby excess water intake was provoked by methamphetamine use, leading to severe hyponatraemia, and in the context of seizures and combined antiretroviral therapy, the subsequent development of rhabdomyolysis.…”

Sheehan syndrome presenting as acute renal failure: A rare case report from Somalia

“…They stated that their patient needed 3 sessions of hemodialysis to recover from acute renal failure, while our patient did not need any hemodialysis sessions [ 10 ]. In 2019, Kennedy and co-workers presented a case of a 55-year-old woman who presented with rhabdomyolysis secondary to adrenal insufficiency [ 11 ]. In contrast to the present case, they stated the cause of adrenal insufficiency was autoimmune hypophysitis related to autoimmune hepatitis, while in our case the cause of hypopituitarism was SS secondary to postpartum hemorrhage.…”